Nous rapportons un cas de cryptococcose disseminee chez un patient presentant une lymphopenie CD 4 idiopathique. La presentation clinique initialement musculaire est tout-a-fait particuliere. Le diagnostic est evoque sur la mise en evidence de levures encapsulees a l'examen histologique de la peau et du muscle, retrouvees egalement dans le liquide cephalo-rachidien, les hemocultures, le lavage broncho-alveolaire. Le controle de la maladie est obtenu avec un traitement par amphotericine B pendant 2 mois 1/2 puis par itraconazole a vie en raison de la persistance d'une profonde lymphopenie CD 4 d'etiologie indeterminee.

Primary and secondary amyloidosis are not uncommun in aging dot the diagnosis is rarely made on account of the risk of bleeding in the site of biopsies and the difficulty to distinguish senile from systemic amyloidosis on the biopsy samples. We have studied the frequency of amyloid deposition in the abdominal fat aspirate (AFA), the labial salivary gland (LSG), the temporal arteries (four cases), bone marrow (two cases), digestive tract (four cases) in 100 elderly patients (aged 80 or greater). AFA was positive in 15 percent of the patients and LSG in 5%; both samples were positive in 48. Four cases of systemic amyloidosis were found (two of the AL and two of the the AA type). Sensitivity of AFA was 75%, specificity was 87% and the positive predictive value was 20%. The values were respectively 100%, 99%, 100% for LSG. In I I patients whose AFA biopsies samples were singly positive, amyloid deposits were found in temporal arteries in four of four cases. We conclude that AFA is too sensitive for the diagnosis of systemic amyloidosis in aging. The responsibility of senile amyloid deposition on AFA should require further investigations. LSG biopsies seem to be a more reliable test for the diagnosis of primary and secondary amyloidosis in elderly.

We report a case of invasive cryptococcosis in a patient with idiopathic CD4 T lymphocytopenia. The presenting feature as a profound muscle weakness is particular. The diagnostic is evocated by the presence of encapsulated yeast on the histology of the skin and of the muscle and also in cerebrospinal fluid, blood-culture and bronchoalveolar lavage. The disease control is obtained with amphotericin B during two months a half and itraconazole all life long because of the persistance of profound CD4 T lymphocytopenia unexplained.

Primary and secondary amyloidosis are not uncommon in aging but the diagnosis is rarely made on account of the risk of bleeding in the site of biopsies and the difficulty to distinguish senile from systemic amyloidosis on the biopsy samples. We have studied the frequency of amyloid deposition in the abdominal fat aspirate (AFA), the labial salivary gland (LSG), the temporal arteries (four cases), bone marrow (two cases), digestive tract (four cases) in 100 elderly patients (aged 80 or greater). AFA was positive in 15 percent of the patients and LSG in 5%; both samples were positive in 4%. Four cases of systemic amyloidosis were found (two of the AL and two of the AA type). Sensitivity of AFA was 75%, specificity was 87% and the positive predictive value was 20%. The values were respectively 100%, 99%, 100% for LSG. In 11 patients whose AFA biopsies samples were singly positive, amyloid deposits were found in temporal arteries in four of four cases. We conclude that AFA is too sensitive for the diagnosis of systemic amyloidosis in aging. The responsibility of senile amyloid deposition on AFA should require further investigations. LSG biopsies seem to be a more reliable test for the diagnosis of primary and secondary amyloidosis in elderly.

Les amyloses systémiques AL et AA ne sont pas exceptionnelles en gériatrie, mais leur diagnostic est rarement posé du vivant du malade en raison des risques hémorragiques associés aux biopsies d'organes. L'examen de l'aspiration de la graisse sous-cutanée abdominale et des biopsies des glandes salivaires accessoires récemment proposé comme alternative aux biopsies d'organes pourrait permettre d'améliorer le score diagnostique de l'amylose en gériatrie. Nous avons étudié de façon prospective la fréquence des dépôts amyloïdes dans la graisse sous-cutanée abdominale et les glandes salivaires accessoires prélevés chez 100 malades âgés de 80 ans et plus, ainsi que sur les biopsies d'artère temporale de quatre d'entre eux, la moelle osseuse (deux cas), le tractus digestif (quatre cas). L'aspiration de graisse sous-cutanée était positive dans 15% des cas et les biopsies des glandes salivaires dans 5% ; les deux échantillons étaient simultanément positifs dans 4% des cas. Quatre cas d'amylose systémique ont été découverts (deux de type AL et deux de type AA). La sensibilité de la graisse était de 75%, la spécificité de 87%, la valeur prédictive négative de 98% et la valeur prédictive positive de 20%. Ces valeurs étaient respectivement de 100%, 99%, 80% et 100% pour les glandes salivaires accessoires. Des dépôts amyloïdes étaient présents sur les biopsies d'artère temporale de quatre patients issus d'un groupe de 11 malades dont la graisse était positive isolément. Nous concluons que l'examen de la graisse sous-cutanée abdominale est trop sensible pour le diagnostic de l'amylose systémique chez le sujet âgé ; la responsabilité d'une contamination des prélèvements par de l'amylose sénile mérite d'être discutée. L'examen des glandes salivaires accessoires semble être le meilleur test diagnostique pour ces affections.

Study of the presence of amyloid deposits on subcutaneous fat aspirates was carried out in 100 patients hospitalized in a geriatric unit. The test was positive in 15%, and in 4% of them, amyloid deposits were also seen on accessory salivary glands, confirmed by immunohistochemical staining. These results indicate that sub-cutaneous fat aspirate may be a useful test for an early diagnosis of amyloidosis.

Study of the presence of amyloid deposits on subcutaneous fat aspirates was carried out in 100 patients hospitalized in a geriatric unit. The test was positive in 15%, and in 4% of them, amyloid deposits were also seen on accessory salivary glands, confirmed by immunohistochemical staining. These results indicate that sub-cutaneous fat aspirate may be a useful test for an early diagnosis of amyloidosis.

In 14 of 23 patients seen with coeliac disease thrombocytosis was present (range: 420 000 to 789 000 platelets per cubic mm) and was unrelated to iron deficiency or inflammatory syndrome. Among patients with thrombocytosis (group I), 6 had an associated autoimmune disease; this association was absent in patients without thrombocytosis (group II). There was no correlation betwen thrombocytosis and lymphocyte count, plasma IgA, IgG, IgM and fibrinogen levels, presence of HLA B8 antigen or histological stage. On the other hand, group I patients had a lower plasma level of albumin, phosphorus and folates. We conclude that thrombocytosis is useful in the assessment of patients with coeliac disease and reflects an enhanced activity of the disease. Moreover, the presence of thrombocytes in these patients' blood may indicate a major risk of associated autoimmune disease.

Study of the presence of amyloid deposits on subcutaneous fat aspirates was carried out in 100 patients hospitalized in a geriatric unit. The test was positive in 15%, and in 4% of them, amyloid deposits were also seen on accessory salivary glands, confirmed by immunohistochemical staining. These results indicate that sub-cutaneous fat aspirate may be a useful test for an early diagnosis of amyloidosis.

In 14 of 23 patients seen with coeliac disease thrombocytosis was present (range: 420,000 to 789,000 platelets per cubic mm) and was unrelated to iron deficiency or inflammatory syndrome. Among patients with thrombocytosis (group I), 6 had an associated autoimmune disease; this association was absent in patients without thrombocytosis (group II). There was no correlation between thrombocytosis and lymphocyte count, plasma IgA, IgG, IgM and fibrinogen levels, presence of HLA B8 antigen or histological stage. On the other hand, group I patients had a lower plasma level of albumin, phosphorus and folates. We conclude that thrombocytosis is useful in the assessment of patients with coeliac disease and reflects an enhanced activity of the disease. Moreover, the presence of thrombocytes in these patients' blood may indicate a major risk of associated autoimmune disease.

Spontaneous rupture of spleen in a patient with association of polychondritis and chronic myelomonocytic leukemia. We report a new case of this association and study the other case of the literature.